Doylestown Hospital ranks high on government's list of best heart-attack facilities

Steven Guidern, MD, director of Cath Labs (center), guides a coronary catheter in the heart of a patient during testing at Doylestown Hospital. He is assisted by Laura Lackman, registered cardiac invasive specialist (left) and Ray Beaudoin, RN (right). Doylestown Hospital is ranked second in saving people from heart attacks. One of the reasons is that they are fast at using a ballon to open up blocked arteries. February 11, 2013. ( MICHAEL S. WIRTZ / Staff Photographer ). (MICHAEL S. WIRTZ / Staff Photographer)

BY TOM AVRIL, Inquirer Staff Writer

Posted: February 22, 2013

BARBARA TAYLOR woke at 3 a.m. with chest pain and thought it might be indigestion. Then her jaw began to hurt, so she woke her husband, who took her to Doylestown Hospital.

Taylor, 61, was having a heart attack, and she went to the hospital that is second-best in the country at keeping such patients alive, according to Medicare data from the federal government.

The sooner a doctor performs angioplasty - using a tube called a catheter and a small balloon to open a blocked artery - the better. Doylestown says it pushes its system at full throttle, often activating its catheterization lab well before the patient gets to the hospital. If there are a few false alarms, in which the patient turns out not to have a heart attack, so be it. The ones with a real problem are likely to make it.

Of the 250 Medicare patients who went to Doylestown Hospital with a heart attack from July 1, 2008, to June 30, 2011, just 10.4 percent died within 30 days. Nationally, the 30-day mortality rate is 15.5 percent, according to the Centers for Medicare & Medicaid Services.

The government warns against using its figures to rank hospitals. Instead, it uses a statistical model to put facilities in one of three categories: better, no different or worse than the national rate.

But that is being overly cautious with the statistics, said Ashish Jha, associate professor of health policy and management at the Harvard School of Public Health. There are plenty of standouts and laggards hiding in the "no different" category, he said.

A hospital such as Doylestown, which is among the few that the government classifies as better than average, is likely doing an especially good job, he said.

"I wouldn't make a big deal if a hospital was 33rd vs. 34th, but I would make a big deal if a hospital were second vs. 34th," Jha said.

Of the 133 Pennsylvania hospitals for which numbers were available, none was worse than the national average, according to the government's model. Five were better than average, led by Doylestown. Just behind it was Main Line Health's Lankenau Medical Center, at 10.7 percent mortality. (The rest of the top five were outside this area.)

Doylestown's speed and skill is the result of several factors, said interventional cardiologist David Boland, director of the hospital's chest-pain center.

Often, an electrocardiogram is administered by emergency responders before the patient reaches the hospital - either in the ambulance or at the patient's home. If the EKG indicates a heart attack, the ambulance squad calls the hospital, where doctors and nurses immediately activate the catheterization lab, where angioplasty is done.

If there's any question about the diagnosis, the ambulance squad sends the EKG to the hospital for a physician to read. After receiving it, the physician activates the cath lab.

In the old days, a patient would not get an EKG until reaching the hospital. The cardiologist on call would be paged to read the scan, and only after that would other personnel be summoned. No longer, Boland said.

"It became apparent that the best way to effectively treat somebody is to take out all the middle people," Boland said. "They're almost bypassing the emergency room and just coming right up to the cath lab."

Yet Doylestown is not the only hospital that has engaged ambulance squads to perform EKGs, nor is it the only hospital to cut out intermediate steps. Why are so many more people surviving?

Harvard's Jha said heart-attack mortality is a black-and-white statistic that is not susceptible to fudging, nor it is affected by socioeconomic factors. If a hospital's scores are good, it is very likely the result of skill, training and good procedure, he said.

Boland said another factor may be that many patients, doctors and nurses live close to hospitals, and that there are relatively few traffic jams in the area.

Indeed, Taylor lives five minutes from Doylestown, in New Britain.

Her primary recollection of her time at the hospital is one of speed: "People were just fluttering around like boom, boom, boom! Everything happened so fast."

It took 67 minutes from her arrival for clinicians to open her blocked artery, a period called the door-to-balloon time. That's well below the industry standard of 90 minutes, though it might have been even faster had she taken an ambulance, with the EKG performed in advance.

Boland said the hospital often posts door-to-balloon times below 30 minutes.

The government's goal in posting the data is not to encourage patients with chest pain to log on to their computers to find the best hospital. If you feel chest pain or other symptoms, get to a hospital fast. Don't waste time going to a better hospital that is 15 minutes farther away.

But if you happen to live near Doylestown, your chances after a heart attack look pretty good.